Stimulant Drugs
What Are Stimulants?
Stimulant drugs are a class of psychoactive drug that provides temporary improvements in physical or mental functioning, elevating mood and increasing feelings of wellbeing, energy and alertness. Stimulants are often called "uppers".
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Large doses can cause over-stimulation, resulting in anxiety, panic, seizures, headaches, stomach cramps, aggression and paranoia. Long-term use of strong stimulants can have adverse effects.
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Stimulants can be in the form of tablets, capsules, powders, and small chunky clear crystals or a white or brownish crystal-like powder with a strong smell and bitter taste.
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Examples of stimulant drugs include cocaine, methamphetamines, amphetamines, nicotine and ecstasy.
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Illicit stimulants are usually snorted, swallowed, smoked or injected. Prescribed stimulants are usually taken orally, and how long the effects last differs depending on the type
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Stimulants are widely used as both recreational and prescription drugs. Note that amphetamines, a common stimulant drug, are prescribed and produced, and sold illegally. A healthcare provider may prescribe a stimulant drug to treat narcolepsy, promote weight loss, or treat ADHD and clinical depression. Over time, stimulant drug abuse disrupts the functioning of the brain’s dopamine system and eventually dampens the user's ability to feel any pleasure at all.
Types of stimulants
Overdose deaths from methamphetamine use are rising, with more than 16,500 people dying in 2019.
Methamphetamine
Methamphetamine is a stimulant drug usually used as a white, bitter-tasting powder or a pill. Crystal methamphetamine is a form of the drug that looks like glass fragments or shiny, bluish-white rocks.
What is methamphetamine?
Methamphetamine is a powerful, highly addictive stimulant that affects the central nervous system. Crystal methamphetamine is a form of the drug that looks like glass fragments or shiny, bluish-white rocks. It is chemically similar to amphetamine, a drug used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy, a sleep disorder.
How is methamphetamine used?
People can take methamphetamine by:
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smoking
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swallowing (pill)
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snorting
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injecting the powder that has been dissolved in water/alcohol
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Because the "high" from the drug both starts and fades quickly, people often take repeated doses in a "binge and crash" pattern. In some cases, people take methamphetamine in a form of binging known as a "run," giving up food and sleep while continuing to take the drug every few hours for up to several days.
How does methamphetamine affect the brain?
Methamphetamine increases the amount of the natural chemical dopamine in the brain. Dopamine is involved in body movement, motivation, and reinforcement of rewarding behaviors. The drug’s ability to rapidly release high levels of dopamine in reward areas of the brain strongly reinforces drug-taking behavior, making the user want to repeat the experience.
Short-Term Effects
Taking even small amounts of methamphetamine can result in many of the same health effects as those of other stimulants, such as cocaine or amphetamines. These include:
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increased wakefulness and physical activity
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decreased appetite
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faster breathing
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rapid and/or irregular heartbeat
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increased blood pressure and body temperature
Long-Term Effects
People who inject methamphetamine are at increased risk of contracting infectious diseases such as HIV and hepatitis B and C. These diseases are transmitted through contact with blood or other bodily fluids that can remain on drug equipment. Methamphetamine use can also alter judgment and decision-making leading to risky behaviors, such as unprotected sex, which also increases risk for infection.
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Methamphetamine use may worsen the progression of HIV/AIDS and its consequences. Studies indicate that HIV causes more injury to nerve cells and more cognitive problems in people who use methamphetamine than it does in people who have HIV and don't use the drug.1 Cognitive problems are those involved with thinking, understanding, learning, and remembering.
Long-term methamphetamine use has many other negative consequences, including:
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extreme weight loss
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addiction
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severe dental problems
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intense itching, leading to skin sores from scratching
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anxiety
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changes in brain structure and function
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confusion
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memory loss
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sleeping problems
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violent behavior
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paranoia—extreme and unreasonable distrust of others
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hallucinations—sensations and images that seem real though they aren't
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In addition, continued methamphetamine use causes changes in the brain's dopamine system that are associated with reduced coordination and impaired verbal learning. In studies of people who used methamphetamine over the long term, severe changes also affected areas of the brain involved with emotion and memory.2 This may explain many of the emotional and cognitive problems seen in those who use methamphetamine.
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Although some of these brain changes may reverse after being off the drug for a year or more, other changes may not recover even after a long period of time.3 A recent study even suggests that people who once used methamphetamine have an increased the risk of developing Parkinson's disease, a disorder of the nerves that affects movement.4
Can a person overdose on methamphetamine?
Yes, a person can overdose on methamphetamine. An overdose occurs when the person uses too much of a drug and has a toxic reaction that results in serious, harmful symptoms or death.
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In 2017, about 15 percent of all drug overdose deaths involved the methamphetamine category, and 50 percent of those deaths also involved an opioid, with half of those cases related to the synthetic opioid fentanyl. It is important to note that cheap, dangerous synthetic opioids are sometimes added to street methamphetamine without the user knowing
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Additives such as fentanyl has been found in methamphetamine which has caused increased overdose deaths.
How is methamphetamine addiction treated?
While research is underway, there are currently no government-approved medications to treat methamphetamine addiction. The good news is that methamphetamine misuse can be prevented and addiction to the drug can be treated with behavioral therapies. The most effective treatments for methamphetamine addiction so far are behavioral therapies, such as:
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cognitive-behavioral therapy, which helps patients recognize, avoid, and cope with the situations likely to trigger drug use.
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motivational incentives, which uses vouchers or small cash rewards to encourage patients to remain drug-free
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Research also continues toward development of medicines and other new treatments for methamphetamine use, including vaccines, and noninvasive stimulation of the brain using magnetic fields. People can and do recover from methamphetamine addiction if they have ready access to effective treatments that address the multitude of medical and personal problems resulting from long-term use.
Cocaine
Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. As a street drug, cocaine looks like a fine, white, crystal powder. Street dealers often mix it with things like cornstarch, talcum powder, or flour to increase profits. They may also mix it with other drugs such as the stimulant amphetamine, and fentanyl .
Overdose deaths from cocaine use are rising, with more than 16,000 people dying in 2019.
What is cocaine?
Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. Although health care providers can use it for valid medical purposes, such as local anesthesia for some surgeries, recreational cocaine use is illegal. As a street drug, cocaine looks like a fine, white, crystal powder. Street dealers often mix it with things like cornstarch, talcum powder, or flour to increase profits. They may also mix it with other drugs such as the stimulant amphetamine, or synthetic opioids, including fentanyl. Adding synthetic opioids to cocaine is especially risky when people using cocaine don’t realize it contains this dangerous additive. Increasing numbers of overdose deaths among cocaine users might be related to this tampered cocaine.
How is Cocaine used?
People snort cocaine powder through the nose, or they rub it into their gums. Others dissolve the powder and inject it into the bloodstream. Some people inject a combination of cocaine and heroin, called a Speedball.
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Another popular method of use is to smoke cocaine that has been processed to make a rock crystal (also called "freebase cocaine"). The crystal is heated to produce vapors that are inhaled into the lungs. This form of cocaine is called Crack, which refers to the crackling sound of the rock as it's heated. Some people also smoke Crack by sprinkling it on marijuana or tobacco, and smoke it like a cigarette.
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People who use cocaine often take it in binges—taking the drug repeatedly within a short time, at increasingly higher doses—to maintain their high.
How does cocaine affect the brain?
Cocaine increases levels of the natural chemical messenger dopamine in brain circuits related to the control of movement and reward.
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Normally, dopamine recycles back into the cell that released it, shutting off the signal between nerve cells. However, cocaine prevents dopamine from being recycled, causing large amounts to build up in the space between two nerve cells, stopping their normal communication. This flood of dopamine in the brain’s reward circuit strongly reinforces drug-taking behaviors. With continued drug use, the reward circuit may adapt, becoming less sensitive to the drug. As a result, people take stronger and more frequent doses in an attempt to feel the same high, and to obtain relief from withdrawal.
Short-Term Effects
Short-term health effects of cocaine include:
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extreme happiness and energy
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mental alertness
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hypersensitivity to sight, sound, and touch
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irritability
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paranoia—extreme and unreasonable distrust of others
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Some people find that cocaine helps them perform simple physical and mental tasks more quickly, although others experience the opposite effect. Large amounts of cocaine can lead to bizarre, unpredictable, and violent behavior.
Cocaine's effects appear almost immediately and disappear within a few minutes to an hour. How long the effects last and how intense they are depend on the method of use. Injecting or smoking cocaine produces a quicker and stronger but shorter-lasting high than snorting. The high from snorting cocaine may last 15 to 30 minutes. The high from smoking may last 5 to 10 minutes.
What are the other health effects of cocaine use?
Other health effects of cocaine use include:
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constricted blood vessels
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dilated pupils
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nausea
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raised body temperature and blood pressure
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fast or irregular heartbeat
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tremors and muscle twitches
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restlessness
Long-Term Effects
Some long-term health effects of cocaine depend on the method of use and include the following:
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snorting: loss of smell, nosebleeds, frequent runny nose, and problems with swallowing
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smoking: cough, asthma, respiratory distress, and higher risk of infections like pneumonia
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consuming by mouth: severe bowel decay from reduced blood flow
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needle injection: higher risk for contracting HIV, hepatitis C, and other bloodborne diseases, skin or soft tissue infections, as well as scarring or collapsed veins
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However, even people involved with non-needle cocaine use place themselves at a risk for HIV because cocaine impairs judgment, which can lead to risky sexual behavior with infected partners (see "Cocaine, HIV, and Hepatitis" textbox).
Cocaine, HIV, and Hepatitis
Methamphetamine is a powerful, highly addictive stimulant that affects the central nervous system. Crystal methamphetamine is a form of the drug that looks like glass fragments or shiny, bluish-white rocks. It is chemically similar to amphetamine, a drug used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy, a sleep disorder.
Other long-term effects of cocaine use include being malnourished, because cocaine decreases appetite, and movement disorders, including Parkinson’s disease, which may occur after many years of use. In addition, people report irritability and restlessness from cocaine binges, and some also experience severe paranoia, in which they lose touch with reality and have auditory hallucinations—hearing noises that aren't real.
Can a person overdose on cocaine?
Yes, a person can overdose on cocaine. An overdose occurs when a person uses enough of a drug to produce serious adverse effects, life-threatening symptoms, or death. An overdose can be intentional or unintentional.
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Death from overdose can occur on the first use of cocaine or unexpectedly thereafter. Many people who use cocaine also drink alcohol at the same time, which is particularly risky and can lead to overdose. Others mix cocaine with heroin, another dangerous—and deadly—combination.
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Some of the most frequent and severe health consequences of overdose are irregular heart rhythm, heart attacks, seizures, and strokes. Other symptoms of cocaine overdose include difficulty breathing, high blood pressure, high body temperature, hallucinations, and extreme agitation or anxiety.
How does cocaine use lead to addiction?
As with other drugs, repeated use of cocaine can cause long-term changes in the brain’s reward circuit and other brain systems, which may lead to addiction. The reward circuit eventually adapts to the extra dopamine caused by the drug, becoming steadily less sensitive to it. As a result, people take stronger and more frequent doses to feel the same high they did initially and to obtain relief from withdrawal.
Withdrawal symptoms include:
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depression
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fatigue
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increased appetite
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unpleasant dreams and insomnia
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slowed thinking
How can people get treatment for cocaine addiction?
Behavioral therapy may be used to treat cocaine addiction. Examples include:
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cognitive-behavioral therapy
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contingency management or motivational incentives—providing rewards to patients who remain substance free
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therapeutic communities—drug-free residences in which people in recovery from substance use disorders help each other to understand and change their behaviors
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community based recovery groups, such as 12-step programs
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While there are no FDA-approved medications for the treatment of cocaine use disorder, NIDA supports a robust medication development pipeline in this area.
Approximately 5 million Americans misused prescription stimulants in 2020
Amphetamines
These drugs increase the neurotransmitter dopamine in the brain, which can result in improved alertness, focus, and feelings of euphoria. Too much amphetamine at once, however, can lead to amphetamine overdose— a serious and life-threatening health emergency.
What are Amphetamines?
Amphetamines are stimulants that speed up the body’s system. Some are legally prescribed and used to treat attention-deficit hyperactivity disorder (ADHD).
What are common street names?
Common street names include:
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Bennies
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Black Beauties
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Crank
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Ice
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Speed
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Uppers
What do they look like?
Amphetamines can look like pills or powder. Common prescription amphetamines include amphetamine and dextroamphetamine (Adderall®), dextroamphetamine (Dexedrine®), lisdexamphetamine (Vyvanse™) and methamphetamine (Desoxyn®).
How are they abused?
Amphetamines are generally taken orally or injected. However, the addition of “ice,” the slang name of crystallized methamphetamine hydrochloride, has promoted smoking as another mode of administration. Just as “crack” is smokable cocaine, “ice” is smokable methamphetamine.
What is their effect on the mind?
The effects of amphetamines are similar to cocaine, but their onset is slower and their duration is longer. In contrast to cocaine, which is quickly removed from the brain and is almost completely metabolized, methamphetamine remains in the central nervous system longer, and a larger percentage of the drug remains unchanged in the body, producing prolonged stimulant effects.
Chronic abuse produces a psychosis that resembles schizophrenia and is characterized by paranoia, picking at the skin, preoccupation with one’s own thoughts, and auditory and visual hallucinations. Violent and erratic behavior is frequently seen among chronic users of amphetamines.
What is their effect on the body?
Physical effects of amphetamine use include:
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Increased blood pressure and pulse rates
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Insomnia
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loss of appetite
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Physical exhaustion
What are their overdose effects?
Overdose effects include:
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Agitation
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Increased body temperature
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Hallucinations
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Convulsions
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Possible death
What is their legal status in the United States?
Many amphetamines are Schedule II stimulants, which means that they have a high potential for abuse and a currently acceptable medical use (in FDA-approved products). Pharmaceutical products are available only through a prescription that cannot be refilled.